Ewertz Marianne, Qvortrup Camilla, Eckhoff Lise
Department of Oncology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Denmark.
Acta Oncol. 2015 May;54(5):587-91. doi: 10.3109/0284186X.2014.995775. Epub 2015 Mar 9.
Chemotherapy with taxanes and platinum compounds has resulted in substantial survival benefits both in adjuvant and metastatic settings. However, as a side effect, such chemotherapy may cause peripheral neuropathy (CIPN) which may result in discontinuation of treatment, and if it persists after treatment completion, has a negative impact on quality of life (QoL).
Symptoms of CIPN are sensory, like pain, numbness, and tingling, typically located in the hands and feet. For oxaliplatin, there is an acute form of CIPN, resulting in paraesthesias in the mouth and throat during or shortly after the infusion triggered by exposure to cold. Risks factors for CIPN include preexisting neuropathy, either from treatment with other neurotoxic agents, or from comorbid conditions. The incidence of CIPN is related to dose per cycle, cumulative dose, and duration of infusion. While cisplatin-induced neuropathy is irreversible, CIPN induced by taxanes may persist for several years in about 30% of patients. Evidence from the literature is suggestive that CIPN is likely to be negatively associated with QoL. No agents have been identified to be recommended for the prevention of CIPN. For treatment of CIPN, the best available data supports a moderate recommendation for treatment with duloxetine and evidence is inconclusive regarding the use of tricyclic antidepressants (such as nortriptyline), gabapentin, and a compounded topical gel containing baclofen, amitriptyline HCL, and ketamine.
Research is still needed to predict which patients are at high risk of developing CIPN during treatment and in whom CIPN will persist after completion of chemotherapy.
紫杉烷类和铂类化合物化疗在辅助治疗和转移性疾病治疗中均带来了显著的生存获益。然而，作为一种副作用，此类化疗可能会导致外周神经病变（CIPN），这可能会导致治疗中断，并且如果在治疗结束后仍持续存在，会对生活质量（QoL）产生负面影响。
CIPN的症状为感觉异常，如疼痛、麻木和刺痛，通常位于手和脚。对于奥沙利铂，存在一种急性形式的CIPN，在输注期间或输注后不久，因接触寒冷而引发口腔和咽喉的感觉异常。CIPN的风险因素包括既往存在的神经病变，其可能源于其他神经毒性药物的治疗，或合并症。CIPN的发生率与每周期剂量、累积剂量和输注持续时间有关。虽然顺铂引起的神经病变是不可逆的，但紫杉烷类引起的CIPN在约30%的患者中可能会持续数年。文献证据表明，CIPN可能与QoL呈负相关。尚未确定有推荐用于预防CIPN的药物。对于CIPN的治疗，现有最佳数据支持对度洛西汀治疗的中度推荐，而关于三环类抗抑郁药（如去甲替林）、加巴喷丁以及含有巴氯芬、盐酸阿米替林和氯胺酮的复合外用凝胶的使用证据尚无定论。
仍需要开展研究以预测哪些患者在治疗期间发生CIPN的风险较高，以及哪些患者在化疗结束后CIPN仍会持续存在。
